by Marion Nestle

Currently browsing posts about: Supplements

Sep 24 2021

Weekend reading: Immunity, Covid-19, and Generally Good Health

A reader, Philly Nassau, sent me the ingredient list of several “immune-boosting” supplements, in quotes because I am a supplement skeptic in general, and of immune supplements in particular (I favor eating healthfully and staying active).

Immune supplements claim to be “Nootropics and Brain Supplement for Memory, Brain Support, Clarity, Focus, Mood Boost, Anti Anxiety & Stress Relief.”  Nootropics?  These are defined as drugs or supplements capable of enhancing memory, concentration, or other cognitive functions and of preventing cognitive decline.  How I wish.

But first, the science.

  • Gut-microbiota-targeted diets modulate human immune status.  “The data highlight how coupling dietary interventions to deep and longitudinal immune and microbiome profiling can provide individualized and population-wide insight. Fermented foods may be valuable in countering the decreased microbiome diversity and increased inflammation pervasive in industrialized society.”
  • The Stanford press release on this paper. A fermented-food diet increases microbiome diversity and lowers inflammation, Stanford study finds.  Stanford researchers discover that a 10-week diet high in fermented foods boosts microbiome diversity and improves immune responses.
  • The New York Times account: How Fermented Foods May Alter Your Microbiome and Improve Your Health.  Foods like yogurt, kimchi, sauerkraut and kombucha increased the diversity of gut microbes and led to lower levels of inflammation.

Beyond eating healthfully and including fermented foods in the diet, here’s what’s being said about diet and immunity.

Jul 12 2021

Conflicted interests? Drugs vs supplements for obesity

Lots of people take supplements in the hope that they will help with body weight.  This is a big market.  Drug companies want in on it.  Most drugs don’t work, or have deal-breaking side effects.  In June,  The FDA approved Novo Nordisk’s Semaglutide for obesity management.

I subscribe to the Obesity and Energetics newsletter, which sends out weekly lists of research, articles, and commentary on those topics—a great way to stay up on current literature.

On July 2, it featured:

This referred to: Perspective: Dietary supplements and alternative therapies for obesity: A Perspective from The Obesity Society’s Clinical Committee.  Srividya Kidambi, John A. Batsis, William T. Donahoo, Ania M. Jastreboff, Scott Kahan, Katherine H. Saunders, Steven B. Heymsfield.  Obesity 23 June 2021.

Our recommendation to clinicians is to consider the lack of evidence for non-FDA-approved dietary supplements and therapies and guide their patients toward tested weight management approaches…we call on regulatory authorities to critically examine the dietary supplement industry, including their role in promoting misleading claims and marketing products that have the potential to harm patients.

I am with the Obesity Society on this one, but what caught my interest was that several of the authors report financial tied to drug companies with interests in pharmacologic approaches to obesity treatment.

Conflicts of interest: SK serves as Medical Editor for TOPS Magazine (TOPS Inc. nonprofit weight loss club) and as Director for the TOPS Center for Metabolic Research at the Medical College of Wisconsin supported by TOPS Inc. JAB’s research reported in this publication was supported in part by the National Institute on Aging of the National Institutes of Health (NIH) under Award Number K23AG051681. JAB reports equity in SynchroHealth LLC. AMJ’s research is supported by the NIH/NIDDK, the American Diabetes Association, Novo Nordisk, and Eli Lilly; she serves as a consultant for Novo Nordisk, Eli Lilly, and Boehringer Ingelheim. SKa has served as a consultant for Novo Nordisk, Vivus, Gelesis, and Pfizer. KHS reports an ownership interest in Intellihealth. SBH reports his position on the Medical Advisory Board of Medifast Corp.

The newsletter also featured the article referred to in the Perspective.

When I clicked on this link, it took me to the page where I could download the pdf.  I got the paper at this site.   But before I could read it, I had to see an ad for Novo Nordisk’s drug, Semaglutide.  Then I scrolled down to get the study:  A Systematic Review of Dietary Supplements and Alternative Therapies for Weight Loss.  John A. Batsis, John W. Apolzan, Pamela J. Bagley, Heather B. Blunt, Vidita Divan, Sonia Gill, Angela Golden, Shalini Gundumraj, Steven B. Heymsfield, Scott Kahan, Katherine Kopatsis … Obesity (2021) 29, 1102-1113

Study conclusion: “There is weak evidence for the efficacy of dietary supplements and alternative therapies.”

Authors’ disclosure: JAB reports equity in SynchroHealth LLC. AG reports consulting with Novo Nordisk and Unjury. SH reports personal fees from Medifast. SKa reports personal fees from Novo Nordisk, Pfizer, Vivus, and Gelesis. DR reports consulting and speaking fees for Novo Nordisk and Astra Zeneca. KHS has a relationship with Intellihealth Inc. SK is the medical director for TOPS Center for Metabolic Health at the Medical College of Wisconsin, which is supported by TOPS Inc. SBH reports his position on the Medical Advisory Board of Medifast Corp.

I much prefer dietary approaches to weight management and policy strategies to make healthy diets the easy choice.

I am almost never in favor of supplements.  The evidence that they do much beyond placebo effects is usually pretty weak.

The ad gives the side effects for Semiglutide; it has to.

My point: all of this seems to be about marketing Semiglutide.

Jul 5 2021

Industry-sponsored study of the week: Prebiotics

I read about this one in NutraIngredients.com.

While previous animal studies have suggested a significant impact of the gut microbiota on the development and maturation of brain networks that underlie emotional behaviour, fewer studies have been conducted on humans. Intake of a galacto-oligosaccharides (GOS) prebiotic over 3 weeks has been shown to lower the secretion of the stress hormone cortisol and emotional processing in healthy adults, suggesting that GOS intake may be useful in modifying anxiety-related psychological mechanisms. However, reviews and meta-analyses on the efficacy of prebiotics for reducing anxiety symptomology are mixed, calling for further well controlled trials in human participants.

I am always curious to know who pays for this kind of research, so I looked up the study.

Anxiolytic effects of a galacto-oligosaccharides prebiotic in healthy females (18-25 years) with corresponding changes in gut bacterial composition.  Nicola Johnstone Chiara Milesi Olivia BurnBartholomeus van den BogertArjen Nauta Kathryn Hart Paul SowdenPhilip W J BurnetKathrin Cohen Kadosh.   Sci Rep 2021 Apr 15;11(1):8302.

The study: “We examined multiple indices of mood and well-being in 64 healthy females in a 4-week double blind, placebo controlled galacto-oligosaccharides (GOS) prebiotic supplement intervention and obtained stool samples at baseline and follow-up for gut microbiota sequencing and analyses. We report effects of the GOS intervention on self-reported high trait anxiety, attentional bias, and bacterial abundance, suggesting that dietary supplementation with a GOS prebiotic may improve indices of pre-clinical anxiety.”

Conflict of interest statement: AN is an employee of FrieslandCampina, Amersfoort, The Netherlands. BvdB reports co-ownership of MyMicroZoo, Leiden, The Netherlands with no financial benefit from contributions to this manuscript. NJ, CM, OB, KH, PS, PWJB and KCK declared no financial or potential conflicts of interest.

Comment:  Probiotics are microorganisms that maintain a healthy microbiome.   They are typically found in fermented foods like yogurt.  Prebiotics are substances in food—or, in this case, supplements—that feed probiotic microbes.  This prebiotic supplement is GOS, a complicated chain of sugar molecules that is found in milk.

Why would an employee of FrieslandCampina want to do this study?  “Milk is the foundation of everything we do at FrieslandCampina.”

Why would a co-owner of MyMicroZoo be interested?  “The MyMicroZoo analysis shows the composition of your microbiota, and gives insight into how to improve your vitality.”

I’m all for eating yogurt (but watch out for the added sugars).  But GOS supplements?  Pardon my industry-induced skepticism.

Jun 10 2021

CBD edibles: catching up

Everybody wants to get into CBD edibles.  They have the potential to make lots of money for lots of people.

Here are a few recent items.

CBD ice cream:  Way back in 2019, Ben and Jerry’s, always on the cutting edge, promised to move right in.  I haven’t seen any yet, but can’t wait.

CBD pet food: Martha Stewart, also ever ahead of the curve, is doing a new line of products.

CBD alcohol: Product names or descriptors such as ‘CBD gin’ or ‘rum infused with CBD’ could prove problematic in the UK, says the Portman Group, as it sets out guidance on marketing CBD…. Read more

CBD supplements: Rugby warriors tackle cannabinoid concerns with CBD startup:  Two professional rugby players have created a startup selling third-party tested CBD supplements that give elite athletes and everyday consumers peace of mind over cannabinoid content.. Read

CBD edible hazards: Four children needed hospital treatment in England after eating sweets thought to have contained cannabis. A 12-year-old boy was discharged on May 1 and the other three were expected to be released from hospital in Surrey after being kept in overnight for monitoring and observation.  Continue Reading

CBD hazard regulation (or lack thereof): CBD experts recommend THC limit for finished products.  CBD industry experts have put together a detailed safety review of THC recommending clear policy recommendations to cut market confusion… Read

Regulations are sure to come, and the sooner the better—for reasons of public safety, but also to give startups some guidelines.

Mar 1 2021

Industry-funded study of the week: vitamin D supplements

The Study:  Maaike J. Bruins and Ulla Létinois. Adequate Vitamin D Intake Cannot Be Achieved within Carbon Emission Limits Unless Food Is Fortified: A Simulation Study.  Nutrients 202113(2), 592; https://doi.org/10.3390/nu13020592

Conclusion: The present study shows that adequate intakes for vitamin D cannot be achieved with the current diet alone within realistic calorie and carbon emission limits, and additional vitamin D sources are needed to overcome the shortfalls. Universal fortification along with small dietary shifts represents an approach to improve the vitamin D status of the general population, at a high acceptability without affecting the carbon footprint.

Conflicts of Interest: M.J.B. and U.L. are employed by DSM Nutritional Products, a manufacturer of nutritional ingredients.

Comment: Study after study shows that vitamin D supplements do not make healthy people healthier, but the idea persists and supplement companies take advantage of faith in these products.  Well, there isn’t much evidence for harm either, but sunshine on skin is a better source by far.

OK.  I know there’s a big controversy about this.

Here’s a study that shows benefits for patients with COVID; supplements were associated with keeping people out of intensive care.  One of its authors has financial ties to supplement companies, but the study has been criticized on other grounds as has a member of the British Parliament who thinks it provides evidence for supplementing everyone.

And here’s an independently funded study in JAMA shows that vitamin D to have no effect on patients hospitalized with Covid-19.

This one, comes with an editorial.

Given the lack of highly effective therapies against COVID-19, except perhaps for corticosteroids, it is important to remain open-minded to emerging results from rigorously conducted studies of vitamin D (despite smaller sample sizes and important limitations of some studies). However, taken together with existing randomized clinical trials of vitamin D administration in hospitalized patients with respiratory infection and critical illness, the results reported by Murai et al12 do not support routine administration of vitamin D in hospitalized patients with moderate to severe COVID-19.

Fortunately, vitamin D supplements are unlikely to be harmful unless taken in very large doses.

Sunshine, anyone?

Jan 25 2021

Conflicts of interest in nutrition research: this week’s example

Selenium, antioxidants, cardiovascular disease, and all-cause mortality: a systematic review and meta-analysis of randomized controlled trials. David JA Jenkins, David Kitts, Edward L Giovannucci, Sandhya Sahye-Pudaruth, Melanie Paquette, Sonia Blanco Mejia, Darshna Patel, Meaghan Kavanagh, Tom Tsirakis, Cyril WC Kendall, Sathish C Pichika, and John L Sievenpiper.  The American Journal of Clinical Nutrition, Volume 112, Issue 6, December 2020, Pages 1642–1652

Background: “Antioxidants have been promoted for cardiovascular disease (CVD) risk reduction and for the prevention of cancer. Our preliminary analysis suggested that only when selenium was present were antioxidant mixtures associated with reduced all-cause mortality.”

Results: No association of selenium alone or antioxidants was seen with CVD and all-cause mortality. However, a decreased risk with antioxidant mixtures was seen for CVD and all-cause mortality when selenium was part of the mix.

Conclusion: The addition of selenium should be considered for supplements containing antioxidant mixtures if they are to be associated with CVD and all-cause mortality risk reduction.

Comment: The results are statistically significant, but not by much (RR: 0.90; 95% CI: 0.82, 0.98; P = 0.02); the Confidence Interval reaches 0.98, which is very close to 1.00, which would show no difference.  But that’s not the real reason for my interest in this one.  The real reason in this astounding conflicts-of-interest statement and the disclaimer that follows it.

Conflicts of interest

DJAJ has received research grants from Loblaw Companies Ltd, the Almond Board of California, Soy Nutrition Institute (SNI), and the Canadian Institutes of Health Research (CIHR). He has received in-kind supplies for trials as a research support from the Almond Board of California, Walnut Council of California, American Peanut Council, Barilla, Unilever, Unico, Primo, Loblaw Companies, Quaker (Pepsico), Pristine Gourmet, Bunge Limited, Kellogg Canada, and WhiteWave Foods. He has been on the speakers’ panel, served on the scientific advisory board, and/or received travel support and/or honoraria from the Loblaw Companies Ltd, Diet Quality Photo Navigation (DQPN), Better Therapeutics (FareWell), Verywell, True Health Initiative (THI), Heali AI Corp, Institute of Food Technologists (IFT), Soy Nutrition Institure (SNI), Herbalife Nutrition Institute (HNI), Herbalife International, Pacific Health Laboratories, Nutritional Fundamentals for Health (NFH), the Soy Foods Association of North America, the Nutrition Foundation of Italy (NFI), the Toronto Knowledge Translation Group (St. Michael’s Hospital), the Canadian College of Naturopathic Medicine, The Hospital for Sick Children, the Canadian Nutrition Society (CNS), and the American Society of Nutrition (ASN). He received an honorarium from the USDA to present the 2013 W. O. Atwater Memorial Lecture. He is a member of the International Carbohydrate Quality Consortium (ICQC). His wife, Alexandra L Jenkins, is a director and partner of INQUIS Clinical Research for the Food Industry; his 2 daughters, Wendy Jenkins and Amy Jenkins, have published a vegetarian book that promotes the use of the plant foods advocated here, The Portfolio Diet for Cardiovascular Risk Reduction; and his sister, Caroline Brydson, received funding through a grant from the St. Michael’s Hospital Foundation to develop a cookbook for one of his studies. CWCK has received grants or research support from the Advanced Food Materials Network, Agriculture and Agri-Foods Canada (AAFC), Almond Board of California, American Peanut Council, Barilla, Canadian Institutes of Health Research (CIHR), Canola Council of Canada, International Nut and Dried Fruit Council, International Tree Nut Council Research and Education Foundation, Loblaw Brands Ltd, Pulse Canada, and Unilever. He has received in-kind research support from the Almond Board of California, American Peanut Council, Barilla, California Walnut Commission, Kellogg Canada, Loblaw Companies, Quaker (PepsiCo), Primo, Unico, Unilever, and WhiteWave Foods/Danone. He has received travel support and/or honoraria from the American Peanut Council, Barilla, California Walnut Commission, Canola Council of Canada, General Mills, International Nut and Dried Fruit Council, International Pasta Organization, Loblaw Brands Ltd, Nutrition Foundation of Italy, Oldways Preservation Trust, Paramount Farms, Peanut Institute, Pulse Canada, Sun-Maid, Tate & Lyle, Unilever, and White Wave Foods/Danone. He has served on the scientific advisory board for the International Tree Nut Council, International Pasta Organization, McCormick Science Institute, and Oldways Preservation Trust. He is a member of the International Carbohydrate Quality Consortium (ICQC), is Executive Board Member of the Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD), is on the Clinical Practice Guidelines Expert Committee for Nutrition Therapy of the EASD and a director of the Toronto 3D Knowledge Synthesis and Clinical Trials foundation. JLS has received research support from the Canadian Foundation for Innovation, Ontario Research Fund, Province of Ontario Ministry of Research and Innovation and Science, Canadian Institutes of Health Research (CIHR), Diabetes Canada, PSI Foundation, Banting and Best Diabetes Centre (BBDC), American Society for Nutrition (ASN), INC International Nut and Dried Fruit Council Foundation, National Dried Fruit Trade Association, The Tate and Lyle Nutritional Research Fund at the University of Toronto, The Glycemic Control and Cardiovascular Disease in Type 2 Diabetes Fund at the University of Toronto (a fund established by the Alberta Pulse Growers), and the Nutrition Trialists Fund at the University of Toronto (a fund established by an inaugural donation from the Calorie Control Council). He has received in-kind food donations to support a randomized controlled trial from the Almond Board of California, California Walnut Commission, American Peanut Council, Barilla, Unilever, Upfield, Unico/Primo, Loblaw Companies, Quaker, Kellogg Canada, WhiteWave Foods, and Nutrartis. He has received travel support, speaker fees, and/or honoraria from Diabetes Canada, Dairy Farmers of Canada, FoodMinds LLC, International Sweeteners Association, Nestlé, Pulse Canada, Canadian Society for Endocrinology and Metabolism (CSEM), GI Foundation, Abbott, Biofortis, ASN, Northern Ontario School of Medicine, INC Nutrition Research & Education Foundation, European Food Safety Authority (EFSA), Comité Européen des Fabricants de Sucre (CEFS), and Physicians Committee for Responsible Medicine. He has or has had ad hoc consulting arrangements with Perkins Coie LLP, Tate & Lyle, Wirtschaftliche Vereinigung Zucker e.V., and Inquis Clinical Research. He is a member of the European Fruit Juice Association Scientific Expert Panel and Soy Nutrition Institute (SNI) Scientific Advisory Committee. He is on the Clinical Practice Guidelines Expert Committees of Diabetes Canada, European Association for the Study of Diabetes (EASD), Canadian Cardiovascular Society (CCS), and Obesity Canada. He serves or has served as an unpaid scientific advisor for the Food, Nutrition, and Safety Program (FNSP) and the Technical Committee on Carbohydrates of the International Life Science Institute (ILSI) North America. He is a member of the International Carbohydrate Quality Consortium (ICQC), executive board member of the Diabetes and Nutrition Study Group (DNSG) of the EASD, and director of the Toronto 3D Knowledge Synthesis and Clinical Trials foundation. His wife is an employee of AB InBev. DK, ELG, SS-P, MP, SBM, DP, MK, TT, and SCP have no conflicts of interest to declare.

Disclaimer: The authors have no relevant conflicts of interest over the past 4 y. DJAJ has received funds for dietary studies from Loblaws, which, during the course of his funding, acquired Shopper’s Drugmart, which is a pharmaceutical company that also sells supplements.

Comment: Here’s one reason why I am not a fan of dietary supplements.  Most independently funded studies show no significant benefit when they are given to healthy people.  The industry needs studies like these for marketing purposes.  I’m not, but if you are worried about selenium, try food.

Jan 21 2021

Vitamin D and coronavirus: more on the ongoing saga

Vitamin D is such a hot topic for its purported role in preventing or treating coronavirus infections that I seem to have written about it four previous times.  These are here, here, here, and here.

Now, a group of 120 scientists has called on world governments to get their populations to increases vitamin D consumption to 2000 to 4000 units per day, five to ten times higher than current recommendations.  Their letter is here.

This is especially interesting because nutrition and health societies in the UK  advise quite the opposite: no change in the usual recommendation for vitamin D intake (400 units/day).  Their report says (my emphasis):

  • Do not offer a vitamin D supplement to people solely to prevent COVID-19, except as part of a clinical trial.
  • Do not offer a vitamin D supplement to people solely to treat COVID-19, except as part of a clinical trial.

I’m always interested to see what ConscienHealth has to say about such things.

The passion of the vitamin D fan club is striking. However, neither passion nor speculation should be a substitute for facts. Right now, the facts tell us that the reason to take a vitamin D supplement is to protect our muscles and bones. Any thought that it will help with COVID-19 is speculation, and taking too much would be quite unwise.

My sentiments precisely.

Dec 24 2020

Using the pandemic as a business opportunity, European version

Food Safety News reports that the European Commission is getting increasingly upset about fraudulent claims that specific food and supplement products will boost immunity and help protect against Covid-19 or even cure it.

Alas, they will not.

The EC is worried about online advertisements.  Food Safety News reported more than 350 cases of such claims in June.  Now there are even more.

In the US, we mostly see this sort of thing—websites from the supplement industry telling you to take supplements.  Here  is what this one claims, with my comments in red.

Supplements can help you address nutrient insufficiencies or deficiencies in your diet—but can they help you fight COVID-19? Not as far as anyone knows.

While there hasn’t been specifically-targeted research to determine which—if any—nutrients should be FDA-approved to ward off the virus, [Indeed] supplements are an ideal way to keep your body and your immune system functioning at optimal levels. No, they are not.  Food works much better.

As a result, many physicians and other health and wellness experts recommend beginning a simple supplement routine to ensure your body has the nutrients it needs to stay healthy.  Many others do not, and neither do I.…The supplements you take during the COVID-19 pandemic may not be specifically developed to ward off the coronavirus. Right.  So don’t expect them to work.

Still, research has shown that they all play an important role in boosting the immune system, preventing respiratory damage, strengthening the body against viral infections, reducing inflammation—or all of the above.  This is true, but largely in experimental studies likely to have been funded by the supplement industry.

Obviously, I am not a fan of supplements.  There just isn’t much evidence that they do anything useful for healthy people, and healthy people are the ones most likely to be taking them.

With respect to Covid-19, the best preventive strategy is avoidance (masks, distancing, etc).

The best immune-boosting strategy is to eat a healthy diet–largely (but not necessarily exclusively) plant-based, balanced in calories, and with minimal amounts of ultra-processed junk foods.

And let’s all hope the vaccination comes soon and works like a charm.

Happy holidays.